In the early morning hours of Tuesday, Oct. 11, Bright Health announced it was pulling out of Colorado and eight other states, meaning the health insurance provider is no longer offering its affordable individual and group plans to consumers in the High Country and across the state.
Peak Health Alliance CEO Ann Ladd said the news came as a complete shock to her. Ladd said the nonprofit was fully focused on submitting comments for the rates Bright Health had proposed earlier this summer as well as preparing for the open enrollment period that allows consumers to choose their plans for the next year.
“My first reaction was, frankly, surprise,” Ladd said.
Peak Health is a local nonprofit health insurance purchasing alliance that was founded in Summit County and negotiates lower insurance rates for Coloradans in rural areas. For the last few calendar years, Bright Health has been Peak Health’s chosen health insurance carrier. Those that are insured by a Peak Health-sponsored plan include 1,760 Summit County individuals, though there are 6,400 individuals across the High Country who are covered by a Bright Health plan through Peak Health.
All of these individuals will be covered by Bright Health through the year’s end. But they will need to choose a new health insurance plan through the Connect for Health Colorado health insurance marketplace during the upcoming open enrollment period, which starts Nov. 1.
Local providers saw the breakup coming
Though Ladd was shocked by the news Tuesday morning, others were braced for Bright Health’s announcement.
“There had been a decent amount of speculation about whether or not they were going to stay in the state of Colorado after they split ways with the (independent physician association),” said Dr. Theresa Clark, psychiatrist and owner of Ten Mile Health & Wellness in Dillon.
Clark is referring to the Central Rockies Physician Practice Associates, which is an independent physicians association made up of 120 providers, mostly from Summit and Eagle counties, who band together to negotiate with insurance companies like Bright Health.
Dr. Andrew Catron, who is president of the group and is formerly an owner of Swan Mountain Women’s Center in Breckenridge, said the group received a notice from Bright Health on Sept. 29 stating that the carrier was terminating its contract with the physician association effective Dec. 31.
This raised an alarm for many local providers since it essentially meant that all 120 providers could no longer accept Bright Health insurance. The move raised questions about the carrier’s presence in Colorado and if it would continue to operate in the state.
Catron said the group reached out to both Peak Health and Bright Health at the time, both of which confirmed that the carrier intended to continue serving Colorado. But less thant two weeks after the carrier cut ties with the group, it announced it was stepping away from Colorado altogether.
“I think it wasn’t surprising, but it’s kind of disappointing for all of the difficulties that they put providers and consumers through,” Clark said. “For them to just — I don’t want to say abandon, it’s a business decision — but for them to just bow out, especially in Summit County, where that’s a major part of affordable mental health care.”
What does this mean for the High Country?
Individuals who are covered by Bright Health will need to choose a new plan during the open enrollment period starting Nov. 1 if they want to be insured through the 2023 calendar year.
As for what this will to do individual pocketbooks, it’s still too early to tell. The Colorado Division of Insurance has another week or so before it will announce rates for 2023 plans.
Bright Health was planning to raise its rates for next year before it decided to withdraw from Colorado, but the assumption was that Bright Health would still offer one of the most affordable options for those living in rural mountain communities like Summit County.
According to the rate filing documents Bright Health submitted, the average rate increase for 2023 across all of the areas it insures was 21%. The division of insurance had yet to approve those rates, but Ladd guessed that the rates that would eventually get approved would still be an average of 10% to 18% lower than comparable plans of other carriers.
Bright Health’s departure doesn’t just impact the wallets of individuals. It also impacts access to care.
Clark pointed out that she’s one of few psychiatrists based in the rural mountain region. Clark said that about 30% to 40% of her patients are currently covered by Bright Health insurance and that they chose this plan for its affordability and because they have significant health conditions that require frequent care. Clark said most other plans available on Colorado’s marketplace have high deductibles. Not only that, but doctors and physicians are frequently out of network. Without Bright Health plans, Clark said some of her patients will now have to pay higher premiums and travel longer distances for the same care they are receiving today.
Clark said she’s already thinking of ways to help her patients by planning to offer payment plans and negotiating with additional insurance carriers so she can broaden her network in the hopes that doing so opens the door for patient access.
In addition, Catron and Ladd both recommended that consumers shop on the Connect for Health Colorado health insurance marketplace and to reach out to navigators who can help individuals select a plan that’s best for them.
A history of problems
It’s not just consumers who are feeling the pains of Bright Health’s breakup with Colorado. Local providers are also worried about the status of the outstanding claim payments that the carrier still owes, some of which are months old.
In November, many Summit County independent medical clinics expressed frustrations with the way Bright Health handled its claims processing. A couple of these clinics, such as Ten Mile Health & Wellness in Dillon and Swan Mountain Women’s Center in Breckenridge, claimed they were missing thousands of dollars as they waited to be paid for their services.
The carrier promised action later that month and for a time, it seemed like some — though not all — issues were getting resolved. Months later, the division of insurance fined the carrier $1 million for the way it was handling those claim payments. The carrier was responsible for paying half of that fine upfront and that the rest of the fine would only be paid if the carrier didn’t fix its issues within 12 months.
As of Wednesday, Oct. 12, Clark said her outstanding balance from Bright Health was about $20,000. Shelby Osborne, physician and co-owner of Swan Mountain, said the outstanding balance from Bright Health was $65,000.
Both Clark and Osborne said they have concerns of Bright Health making good on their payments.
“I would expect to have to fight for every penny of that,” Clark said.
Peak Health Alliance CEO Anne Ladd said that the nonprofit had already been looking for an alternate carrier to partner with in the last few months but that nothing could, or would, come to fruition before the 2023 calendar year. This means that next year, Peak Health will not be offering a sponsored health insurance product.
In an email sent to Peak Health members on the evening of Tuesday, Oct. 11, Ladd wrote “Bright did not always meet our expectations for customer service,” and that “while circumstances outside of our control mean we will not be sponsoring insurance plans in 2023, we are committed to finding a new, reputable carrier partner for 2024.”
Catron voiced his frustration with the nonprofit for not doing more to help the members and communities it serves. Catron pointed out that Peak Health is the organization that chose to work with Bright Health initially and that it continued to work with the carrier despite concerns from the division of insurance and local providers.
“I think it’s disingenuous to say that the circumstances were outside of their control when they are the ones that chose, and then chose to stay with, a very problematic carrier, at least problematic for us as providers,” Catron said.
On the other hand, Clark said she’s unsure how many options Peak Health had to offer any alternatives. As for how successful Peak Health will be in negotiating with a new carrier, Clark said that remains to be seen.
“Concerns about them making the effort? None,” Clark said of Peak Health. “I firmly believe Peak Health will make every effort possible to do what they can, but it ultimately depends on whether or not insurance companies are willing to try to care about more than just their total bottom line.”
Ladd noted that her organization is heading in a “positive” direction with a few different carriers but that due to a non-disclosure agreement, she couldn’t name the carriers or give details. Currently, the organization has a part-time employee living in Summit County, and when asked if they plan to hire a staff member based in Colorado, Ladd said she’s more focused on hiring someone with contracting skills rather than hiring for a physical location.
This content was originally published here.